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Maximizing Opportunity in ICD-10 Delay

Even at the geologic pace at which healthcare industry-wide initiatives frequently move, conversion from the outdated ICD-9 code sets to the new ICD-10 standard has been a particularly slow and rocky ride.

In April, the Department of Health and Human Services announced the conversion deadline will be postponed by an additional year, until Oct. 1, 2014. Previously the changeover date was set for Oct. 1, 2013, and, prior to that set-in-sand deadline, conversion was proposed for Oct. 1, 2011.

All told, by the time the dust and digits settle on ICD-10 conversion, it will have been a project more than two decades in the process.

Now, healthcare providers and insurance companies that were in a race against the clock now face a new problem, maximizing the additional time without bloating expenses.

For TeAM ICD-10 expert Shirley Hardge, the answer is simple.

“Train,” Hardge said. “Train, train, and train some more. In order to get the maximum benefit out of ICD-10 and ensure maximum value from the process, the best thing end users can do is train on how ICD-10 codes will be used and become accustomed to the syntax.”

Hardge feels the delay wasn't a necessity for large clients like the Military Health System, which TeAM supports and warns against a possible two-year delay, as proposed by the American Medical Association. Yet, with the delay upon us, Hardge advises physicians and other end users to immediately begin thinking in the level of specificity required with the more detailed ICD-10 codes. Even in the conversion itself won't come next October, the process of thinking in the new depth available in ICD-10 codes will help smooth the end user transition.

Specificity is more than a buzzword with ICD-10 conversion; it’s a 140,000 code reason for the changeover.

The transition from ICD-9 to ICD-10 is more an expansion, like, say, adding thousands of new roads to the highway system, rather than a translation, like simply changing existing numbers. Unlike its predecessor, the new ICD-10 standard consists of two sets, both designed by the National Center of Health Statistics and based off the World Health Organization’s ICD-10 standard. However, these code sets, ICD-10-CM for diagnosis codes, and ICD-10-PCS for process codes are expanded to fit the needs of the United States’ healthcare industry. All told, there are 68,000 diagnosis codes and nearly 72,000 procedure codes.

By comparison, there are roughly 17,000 ICD-9 codes, often requiring ungainly additional codes for common and important details, such as laterality and episode of care, or the use of technologies that have emerged since the dated ICD-9 set launched, such as an endoscopic procedure.

“Improving physician documentation to come in line with the needs of ICD-10 codes will only help their existing efforts on ICD-9,” Hardge says. “There is no reason to delay in creating the documentation ICD-10 will require.”

According Hardge, it’s all worth the wait.

“The expansion of the number of available codes, the ability to do more comprehensive research, the impact on epidemiology are all going to be of tremendous value,” Hardge said. “Certainly there are some growing pains, but it’s definitely time.”

While the delay affords more time for small healthcare providers, it comes at a cost. The Department of Health and Human Services estimates an addition of 10 to 30 percent of the cost of conversion by delaying an additional year.

For large organizations like the Military Health System, Hardge believes readiness would have been achieved by the changeover date, so the additional year may not have been necessary.

“I think large organizations that have been facing this changeover for some time would’ve made it on the original date,” Hardge said. “There may be some small hiccups, but we are well on our way.”

Yet as much as ICD-10 conversion is about technology, it’s just as much a scheduling challenge.

“It’s important to remember that no changeover is just about a single date,” said Sanjoy Bose, an expert on complex integrated master schedules. “It’s always a process. So instead of thinking about this as a single date, think about it as an extended schedule.

“Even though the deadline has been extended, in large transition events like this, it’s often best to keep the original deadline as an intermediate date, but add extra testing and other dates to the right of original date.”

The biggest advantage of the delay in scheduling, Bose says, is the ability to reduce risks.

“Currently, you’ve already identified the risks in a changeover like this, but you can’t get to everything” he said. “Use the additional time to mitigate those risks and lower the overall risk level Follow the code around your office. Check every place that code interacts, all of its dependencies. Examine your backout plan carefully.”

From a project management standpoint, the delay may not necessarily mean a large increase in cost, Bose notes, if the same resources across a longer period of time.

“If finances are a problem, you can use the same resources allotted for the current conversion, but stagger out the tasks. Therefore, you use the same level of resources, but across a longer timeline.”

For small providers, which form the bulk of the loose alliance supporting the latest delay, Bose advises getting very specific in creating a road map of how to get from ICD-9 use to ICD-10 implementation. A March 2012 survey by the Workgroup for Electronic Data Interchange found that nearly half of its respondents were unaware when they would complete their impact assessment.

“Figure out exactly how this is going to impact your operations, from the start of a session until the conclusion. Document it. Set up a very specific road map with milestones, leading up to the implementation date. Consider all dependencies and risks along the way. Changeovers like these are not weekend projects or projects that can be completed without a specific series of gates and checks along the way. These projects commonly fail because there is not a road map and the participation of each team member isn’t fully explained or understood.”

For all health care providers, Bose recommends that the lessons of this conversion be documented so the next iteration may go smoother.

“Be sure your lessons learned have significance,” Bose said. “Document the roadblocks and the solutions. This isn’t the first major conversion effort in health care and certainly won’t be the last.”

Even if the moving deadlines may sometimes make it feel that way.

About TeAM, Inc.

Founded in 1985, TeAM, an ISO 9001:2008 certified Veteran-Owned Small Disadvantaged Business (VOSDB), is a premier provider of IT solutions to the Federal Government, specializing in all facets of military health care. TeAM, a professional services company, maintains a long and productive relationship with the Department of Defense and numerous federal agencies. Located in Falls Church, Va., and San Antonio, Texas, TeAM is organized to be accessible and responsive to clients' needs, matching superior service with the latest industry methodologies and technologies. Coupling decades of expertise and experience with a firm commitment to client needs, TeAM offers an unparalleled combination of small-business agility with big-business expertise.